Review Article DOI: 10.18231/2455-8486.2017.

0002

Precision attachments- An overview

Reeta Jain1,*, Swati Aggarwal2
1Professor & HOD, 2PG Student, Dept. of Prosthodontics, GIDSR, Ferozepur, Punjab

*Corresponding Author:
Email: rtjn132@gmail.com

Abstract
The awareness and demand for quality of dental treatment is relatively increasing in recent generation. Various options
available for the replacement of partially missing teeth are over dentures, clasp retained removable partial dentures, removable
partial dentures with precision attachments and implants. A removable partial denture with a retained attachment system is one
of the treatment modalities which may assist prosthodontist to achieve better functions and aesthetics in substituting missing teeth
and oral structures. An attachment is defined as “A mechanical device for the fixation, retention and stabilization of prosthesis.”

Keywords: Precision Attachment, Cast partial denture, Partial edentulism, Retention.

Introduction History
The precision attachment denture has long been The historical background of precision attachment
considered advantageous in dentistry as it combines work is somewhat obscure. Stair (1886) devised a
fixed and removable prosthodontics in such a way as to unilateral PRD employing anterior and posterior
create the most esthetic partial denture possible. telescopic abutment restoration.
Nevertheless they have in the past been largely ignored The most important character with the
by most dental professionals for understandable development of precision attachment dentistry was Dr.
reasons, notably cost and inadequate grasp of their Herman ES Chayes 1906 who developed the T shaped
application. Last decade with greater demand for precision attachment.
complex and esthetic restoration and an increase in the 1908 – 1910 He invented a parallelometer.
popularity of implant has brought a concomitant 1912 – Designed Chayes attachment.
increase in the popularity of attachment retained Ash (1912) introduced the split bar attachment
prosthesis. Precision attachments are two precocious system. Chayes also gave the stress breaker design
metal components which are manufactured to form an which is essentially an attachment to which a hinge has
articulate joint [Fig. 1]. First component or matrix is a been added, so allowing limited simple movement this
metal receptacle or keyway, which is positioned within design was later improved by McCollum.(1,2)
the normal clinical contours of a cast restoration placed
on the attachment or the second component or patrix is Classification
attached to the removable partial denture. They are  Based on their method of fabrication and the
designed to replace occlusal rest, bracing arm and tolerance of fit between the components.
retaining arm of the conventional clasp retained partial I. Precision attachment (prefabricated types) 
denture.(1,2) prefabricated machined components with precisely
Synonyms Internal attachments, Frictional attachments, manufactured metal to metal parts with close
Slotted attachments, Parallel attachments, Key and tolerance.
keyway attachments.(3,4) II. Semi precision attachment (laboratory made or
custom made types) components usually originate
as prefabricated or manufactured patterns (made of
plastic, nylon or wax) or Hand waxed.2
 According to their relationship to the
abutment teeth.
1) Intracoronal / internal attachment  If the
attachment resides within the body / normal
contours of the abutment teeth.
2) Extracoronal / external attachment  If the
attachment resides outside the normal clinical
contours of the abutment crown / teeth.(3,5)
Advantages of precision attachments
1. Improved esthetics and elevated psychological
Fig. 1: Matrix and Patrix acceptance. [Fig. 2]

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Reeta Jain et al. Precision attachments- An overview

2. Compared to conventional clasp retained partial Intracoronal attachment based on retention

denture they give better retention and stability, less 1) Passive attachment
liable to fracture than clasp, less bulky. 2) Active attachment – Active friction grip attachment
3. Lateral forces in the abutment during the insertion Active snap grip attachment
and removal are eliminated and more axial force 3) Locked precision attachment
during functions are achieved.
Advantages
1) Improved esthetics (particularly important in
anterior part of mouth)
2) Point of force application to the teeth is more
apical than for occlusal or incisal rest thus
shortening the lever arm and decreasing torquing
forces.
3) Point of application of thrust applied through the
device lies as close as possible to the long axis of
abutment i.e. most favorable position.
4) Natural self cleansing contours of teeth can be
maintained
Disadvantages
1) Requires adequate faciolingual width /
cervicoocclusal height to provide as large as
frictional area as possible between the slot and
Fig. 2: Improved Aesthetics with Precision flange.
Attachments 2) Requires extensive preparation of the abutment
teeth to obtain space for the keyway mechanism.
Disadvantages Various intracoronal attachments McCollum
1. Complexity of design, complex principles and attachment, Stern attachment, Crismani attachment,
procedures for fabrication and clinical treatment. Bakers attachment, Schatzmann attachment, Ney’s
2. Expensive – increased overall cost of the treatment. attachment.(7,8,9)
.
3. Requires high technical expertise for successful 2. Semiprecision Attachment: There is a type of
fabrication experience and knowledge on the part attachment usually referred to as a semiprecision
of dentist and laboratory technician are essential. rest attachment that utilizes an intracoronal rest
4. Increased demand on oral hygiene performance.(6) seat and resilient lingual arm. First semi precision
attachment was constructed by Gillete in 1923.
Requirements According to Louis Blatterfein (1969). In designing
1. Occlusogingival length– minimum of 4 mm of a semiprecision attachment 4 aspects of rest seat
vertical space is required so that there is adequate preparation may be taken into consideration:
space between plane of occlusion and gingiva. Occlusal form, Proximal form, Gingival floor form,
2. Placement of attachments in the incisors can be Proximal surface placement.[Fig. 3]
difficult because or limited faciolingual width.
3. Adequate space between pulp and normal tooth
contour is necessary for the intracoronal
component of an internal attachment.(2,4)

1. Intracoronal Precision Attachment: Intracoronal

attachment were introduced in the late nineteenth
century with substantial contribution from Dr.
Herman ES Chayes.
Intracoronal precision attachment – prefabricated
type: It comes as two component matrix and patrix.
These are often accompanied by paralleling guide that
fits into the dental surveyor as well as the device to
activate the attachment after fabrication. Matrix Fig. 3: Semi Precision Attachments
(female) is waxed into the crown or bonded into a
preparation in the tooth. Patrix (male) is attached to the Advantages
framework usually by soldering. Type of retention is 1. Laboratory fabricated precision attachment offers
either friction or mechanical. far greater adaptability to a wide variety of clinical
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Reeta Jain et al. Precision attachments- An overview

situations compared to prefabricated precision Classified by (Boitel 1978)

attachments. Rigid attachment
2. Versatility for many clinical variation Resilient attachment
3. Variation in tooth size and shapes are most easily Bar attachment
accommodated. Advantages
Disadvantage 1. It does not alter the normal contour of the
1. Long term wear is more abutment, crown being entirely outside the tooth
2. Lack of interchangeability of male and female contour.
attachment as there is no standardization of sizing 2. Easy insertion and greater freedom in design.
as been in prefabricated parts. 3. Do not require space within the contours of the
3. Repair and replacement of custom attachments are abutment tooth hence can be used when there is
more difficult as composed to prefabricated parts. insufficient buccolingual width to accommodate
In 1979 Ira D Wisner discussed about two basic types the intraoral attachment.
of semi-precision attachment Disadvantages
Locking and Non locking.(2,4) 1. Lack of occlusal stability
2. Improper control of force distribution between
3. Extracoronal Attachments: It was introduced by dentulous and edentulous area
Henry R Boos in the early 1900’s and later 3. Maintenance problems
modified by F Ewing Roach (1908).Extracoronal 4. Bulky, break or wear
attachments are retaining devices having part or all 5. Rebasing problem.(10,11,12)
of their mechanism outside the normal contour of
the attachment tooth.[Fig. 4] 4. Magnets as Attachment: Use of magnets started
gaining popularity since 1960 – when magnets
based on rare earth element was developed. These
magnets were of small size having high strength. In
recent years, there has been an increased interest in
the use of magnets, the modern alloy are powerful
and retain their magnetism for a long time. [Fig. 6]

Fig. 4: Extracoronal Attachments with Crowns

Extracoronal attachments provide only retention
but not the lateral force transmission (bracing) or
occlusal force transmission (support) required from a
removable partial denture retainer. Application of these
attachments is in distal extension partial denture when a
mechanical stress breaker is required. (Kennedys Class
I and Class II).[Figure 5]
These attachments are employed to reduce the Fig. 6: Magnetic Precision Attachments
stresses on the abutment teeth and transfer them to the
Magnet used nowadays Samarium cobalt (Sm -co),
denture bearing areas.
Neodymium iron boron (Nd-Fe-B) – 20% strong per
unit volume than the cobalt – samarium alloy,
Samarium-iron-nitride.(13)

5. Auxillary Attachment: A wide variety of

attachments fall into this category only a few most
significant ones are: Screw and tube attachment,
Key and keyway / Interlocks., Presso Matic or
Isoclip, Sectional dentures, Bar connectors.(4)

Conclusion
The precision attachment in combination with
other aspect of advanced partial denture construction
offers us the possibility of making prosthesis that are
Fig. 5: Extracoronal Attachment in Distal Extension esthetic, retentive, strong and problem free and that are
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Reeta Jain et al. Precision attachments- An overview

undetectable by and will not compromise the oral health

of the our patients. The clinician who familiarize
himself with precision attachments will add a new
dimension to his treatment options and this will also
broaden his referral base.(14)

References
1. Patel H, Patel K, Thummer S, Patel RK, ‘Use of
precision attachment and cast partial denture for long-
span partially edentulous mouth - A case report’, Int
Journal of Clinical Dental Science 2014;1(1):22-25.
2. Preiskel HW, ‘Overdenture made easy guide to implant
and root supported prosthesis’, Quintessence Publication
Co., Chicago,1996.
3. Becerra G, Macentee M, ‘A classification of precision
attachments’, J. Prosthet. Dent., 1987;58:322-27.
4. Jumber JF, ‘An Atlas of Overdentures and Attachments’,
Chicago, Quintessence Publication Co., 1981.
5. Merrill C. Mensor JR, ‘Classification and selection of
attachments’, J prosthet dent 1973;29(5):494-97.
6. Preiskel H.W, ‘Precision attachment: Uses and abuses’, J
Prosthet. Dent., 1973;30:491-92.
7. Grosser D, ‘The dynamics of internal precision
attachments’, J. Prosthet. Dent., 1953;3:393-401.
8. Rush Ford C.B, ‘A technique for precision removable
partial denture construction’, J. Prosthet. Dent.,
1974;31:377-83.
9. Koper A, ‘An intracoronal semi-precision retainer for
removable partial dentures – The Thompson Dowel’, J.
Prosthet. Dent., 1973;30:759-68.
10. Terrell W.H, ‘Specialized frictional attachments and their
role in partial denture construction’, J. Prosthet. Dent.,
1951;1:377-50.
11. Mark E. Waltz, ‘Ceka extracoronal attachments’, J.
Prosthet. Dent., 1973,pp.167-71.
12. Precision attachments in prosthodontics; overdenture and
telescopic prosthesis volume 2 quint Pub.
13. Riley MA, Walmsley AD, Harris IR, ‘Magnets in
prosthetic dentistry’, J Prosthet Dent 2001;86:137-42.
14. Makkar S, Chhabra A, Khare A. Attachment retained
removable partial denture: A case report. Int Journal of
Clinical Dental Science 2011;2(2):39-43.

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